Provider Demographics
NPI:1437867132
Name:AWAKE LABS US CORP
Entity Type:Organization
Organization Name:AWAKE LABS US CORP
Other - Org Name:AWAKE LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR OF PARTNER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:651-468-4795
Mailing Address - Street 1:8 THE GRN STE 12893
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 N BROAD STREET
Practice Address - Street 2:SUITE 5, #847
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709
Practice Address - Country:US
Practice Address - Phone:651-353-4404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-10
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies